PSA Tests Can Be Stopped In Some Men

Low risk of prostate cancer death found in men with PSA levels below 3 ng/mL at age 75-80.

ORLANDO—Men who have PSA levels below 3 ng/mL at age 75-80 years may be able to safely discon-tinue regular prostate cancer screenings, according to researchers.

“There is an issue of over-diagnosis and over-treatment, so this is a very important area to study,” said investigator Anna Kettermann, Dipl. Math, MA, a statistician at JohnsHopkinsUniversity in Baltimore.

Kettermann, who presented the study findings here at the American Urological Association annual meeting, said the findings may enable clinicians to better counsel men age 75 and older about the need for regular PSA screening.

Previous studies have shown that prostate cancer screening is an important part of health maintenance and is effective in detecting the disease at its most treatable stages in men. Prostate cancer can be slow growing, and is not always aggressive enough to require immediate treatment. In older men with shorter life expectancies, diagnosis of a non-aggressive prostate cancer following a PSA test can result in increased stress and, possibly, unnecessary treatment.

The research involved 849 men over the age of 40 years in the Baltimore Longitudinal Study of Aging (BLSA), part of the National Institute on Aging. Kettermann and her colleagues examined the proportion of men with aggressive prostate cancer by PSA and age to evaluate the safety of discontinuing PSA testing among older men.

Of these men, 122 had prostate cancer and 35 of those cancer subjects had aggressive disease. After the age of 75, all subjects were divided into two groups by PSA levels (3 ng/mL or above and below 3 ng/mL).

For the men with PSA below 3 ng/mL at age 75-80, the absolute rate of aggressive prostate cancer per 100,000 person years was 67. At the same time, for the men who had PSA levels of 3 ng/mL or higher at age 75-80, the absolute rate was 2,097.

Men who had a PSA level of 3 ng/mL or higher at the age of 75 had an increasing probability of death from prostate cancer. Men in the same age group with a PSA below 3 ng/mL did not share the same risk.

From these results, the researchers concluded that it may be safe to discontinue regular testing in men ages 75-80 with PSA levels below 3 ng/mL as they are unlikely to develop aggressive disease during their remaining life.